ENDOSCOPIC TREATMENT OF POSTOPERATIVE HEMORRHAGE FROM A STAPLED COLORECTAL ANASTOMOSIS

We present the sixth reported case of endoscopic electrocoagulation to successfully treat postoperative hemorrhage from a stapled colorectal anastomosis. A literature review revealed 17 patients with postoperat ive hemorrhage from a combined total of 775 patients (1.8 per cent) af ter stapled colorectal anastomosis requiring blood transfusion and/or emergency surgery. Twelve of the 17 cases involved a circular stapler (71 per cent) used during an anastomosis to the rectum (69 per cent). Nonoperative therapy was successful in 14 of the 17 patients (82 per c ent), using endoscopic electrocoagulation in six patients (43 per cent ) and blood transfusion alone in another six patients (43 per cent). I n follow-up there was one death (cardiac) and two anastomotic fistulas (one requiring temporary colostomy) in the nonoperative group. Both a nastomotic fistulas occurred following hemorrhage from an anastomosis to the rectum using the circular stapler, one after endoscopic electro coagulation and the second after blood transfusion alone. In summary, postoperative hemorrhage from a stapled colorectal anastomosis, althou gh rare, is most likely to occur in a colorectal anastomosis construct ed with the circular stapler. Nonoperative treatment is usually succes sful. Endoscopic electrocoagulation may be safely and effectively used in the early postoperative period to cease unremitting anastomotic he morrhage.